>U)iJBecl 


UC  SOUTHERN  REGIONAL  LIBRARY  FACILiT 


9 
E42a 
1879 


G     000  005  901     4 


THE  LIBRARY 

OF 

THE  UNIVERSITY 

OF  CALIFORNIA 

LOS  ANGELES 


ADDRESS 


DELIVERED    BEFORE    THE 


3^lncri(:an  ^cakmg  0f  Jmtal  Science, 


AT    THEIR 


ELEVENTH  ANNUAL  MEETING, 


Held  in  Boston,  Oct.  30,  1878. 


By  CHARLES   W.  ELIOT,  LL.D., 

PRESIDENT    OF    HABTARD    UNIVERSITY. 


CAMBRIDGE : 

PRESS   OF  JOHN  WILSON  AND   SON. 
1879. 


Xo.  5  Park  Street,  Boston,  Jan.  9,  1879. 

Charles  W.  Eliot,  LL.D.,  President  of  Harvard  University  : 

Dear  Sir,  —  At  the  Eleventh  Annual  Meeting  of  the  American  Acad- 
emy of  Dental  Science,  held  in  Boston,  Oct.  30,  it  was  unanimously 
resolved :  "  That  the  hearty  thanks  of  the  Academy  be  presented  to  Presi- 
dent Eliot,  for  his  very  able  and  excellent  address  ;  and  that  a  copy  be 
requested  for  publication,  and  for  preservation  in  the  archives  of  the  Acad- 
emy." 

Sincerely  hoping  that  you  will  comply  with  this  request,  I  am,  with  high 
regard, 

Very  respectfully  yours, 

Edward  N.  Harris, 

Corresponding  Secretary, 


Harvard  University, 

Cambridge,  Mass.,  11  Jan.,  1879. 

Dear  Sir,  —  It  will  give  me  much  pleasure  to  write  out  in  a  suitable 
form  for  publication  the  remarks  which  I  made  at  the  Annual  Meeting  of 
the  Academy  of  Dental  Science  in  October  last.  Be  pleased  to  convey  to 
the  Academy  my  respectful  acknowledgment  of  the  honor  they  do  me  in 
publishing  ray  address,  and  believe  me,  dear  sir,  with  great  regard, 

Yerj"  truly  yours, 

Charles  W.  Eliot. 
Dr.  Edward  X.  Harris,  Corresponding  Secretary. 


ADDRESS. 


Me.  President,  and  Members  of  the  American  Academy 
OF  Dental  Science  :  — 

In  asking  me,  who  am  not  a  dentist,  to  speak  to 
you,  you  have  determined  beforehand,  for  yourselves, 
the  subject  of  this  annual  address.  You  doubtless 
thought  that,  as  it  is  my  duty  to  watch  the  condition 
and  observe  the  methods  of  professional  education  in 
general,  and  to  study  the  means  by  which  the  lib- 
eral professions  have  been  recruited,  organized,  and 
invested  with  dignity,  my  experience  might  enable 
me  to  make  some  useful  suggestions  concerning  den- 
tal education  and  the  means  of  improving  the  state  of 
the  profession  of  dentistry.  At  any  rate,  these  topics 
are  the  only  ones  which  my  training  and  occupation 
fit  me  to  treat  before  a  body  like  this  ;  so  that  your 
expectation  and  my  desire  to  be  of  some  service,  how- 
ever slight,  to  the  Academy  and  the  profession,  both 
point  to  the  same  themes. 

In  comparison  with  the  three  professions  ordinarily 
called  learned,  dentistry  is  a  new  profession.     It  can 


hardly  be  said  to  have  existed  in  this  country  for  more 
than  seventy  years,  or  two  generations  of  men.  The 
elder  professions  of  theology,  law,  and  medicine,  have 
been  forming  their  usages,  gathering  their  traditions, 
and  establishing  themselves  in  the  respect  and  confi- 
dence of  mankind  for  centuries  ;  and  it  cannot  be 
expected  that  a  profession  so  recent  in  origin  as  den- 
tistry should  already  have  acquired  as  firm  a  posi- 
tion as  theirs,  or  safeguards  as  effective  as  theirs 
against  injurious  influences  from  within  and  from 
without. 

On  the  Avhole,  the  development  of  dentistry  in 
this  country  during  the  past  seventy  years  has  been 
extraordinary  in  many  respects.  The  invention  of 
numerous  instruments  and  mechanical  appliances  of 
great  ingenuity,  the  discovery  of  new  processes,  the 
increase  in  the  number  of  dentists  and  in  the  number 
of  patients,  the  production  of  a  dental  periodical  liter- 
ature and  of  many  books  upon  dentistry,  and  the  cre- 
ation and  growth  of  dental  schools,  are  some  of  the 
most  striking  phenomena  of  this  development.  Many 
causes  have  of  course  conspired  to  produce  so  re- 
markable a  growth ;  but  among  these  causes  four 
deserve  special  mention.  In  the  first  place,  the  labo- 
ratory and  operating-room  of  every  dentist  bear  wit- 
ness to  the  wonderful  fertility  of  the  American  people 
in  mechanical  inventions.  This  fertility,  with  its  many 
advantages,  has  one  serious  drawback,  —  it  seems  to 
have  excluded  or  dwarfed  all  other  kinds  of  inven- 


tiveness.  Secondly,  the  American  mind  is  singularly 
hospitable  to  innovations  ;  that  an  idea,  a  thing,  or  a 
process  is  new,  commends  it  to  Americans  as  to  no 
other  people.  Now,  "  every  medicine  is  an  innova- 
tion," as  Lord  Bacon  says  ;  and,  much  more,  every  ex- 
traction or  filling  of  a  tooth  is  an  innovation  —  often 
a  startling  one.  Thirdly,  the  lamentable  carelessness 
of  Americans  about  fresh  air,  exercise,  and  a  healthful 
diet  has  had  a  great  effect  to  promote  the  growth  of 
dentistry ;  for  artificial  teeth,  and  operations  to  delay 
the  destruction  of  the  natural  teeth,  are  more  needed 
here  than  in  countries  where  the  habits  of  the 
population  are  more  wholesome.  The  European 
peasantry  have  small  need  of  dentistry.  Moreover, 
artificial  teeth  give  better  satisfaction  to  people  who, 
like  most  Americans,  want  to  eat  nothing  but  soft  food, 
than  they  do  to  people  who  have  hard  food  to  masti- 
cate. Lastly,  a  moral  cause  —  a  compound  of  hope- 
fulness and  endurance  —  has  been  a  potent  one.  Pa- 
tience under  present  annoyance  or  pain,  in  the  hope 
of  a  future  advantage,  is  a  national  characteristic 
which  has  many  manifestations.  Many  educated 
Americans  habitually  go  to  a  dentist  twice  a  year, 
and  submit  to  uncomfortable  or  painful  operations, 
in  the  expectation  of  thereby  securing  a  degree  of 
exemption  from  future  suffering  which  will  leave  the 
balance  decidedly  in  their  favor.  An  educated  Euro- 
pean, on  the  other  hand,  to  the  best  of  my  observa- 
tion, seldom  goes  to  a  dentist,  except  for  relief  when 


6 


his  teeth  actually  hurt  him,  just  as  he  waits  to  send 
for  a  physician  until  he  feels  sick.  For  these  reasons, 
with  others,  dentistry  has  grown  faster  in  the  United 
States  than  in  any  other  country  ;  and  in  Europe,  for 
thirty  years  past,  the  art  has  been  considered  pre- 
eminently an  American  art,  and  the  most  success- 
ful practitioners  in  the  European  capitals  have  been 
American  by  birth  or  training. 

If,  then,  the  development  of  dentistry  has  been,  on 
the  whole,  so  remarkable  during  the  past  seventy 
years,  why  is  it  that  dental  magazines,  and  dental  soci- 
eties in  their  discussions,  are  now  constantly  recurring 
to  two  subjects,  —  namely,  the  means  of  improving 
dental  education,  and  of  raising  the  profession  in  pub- 
lic estimation  and  its  own  regard?  Are  there  real 
grounds  for  the  anxiety  which  prompts  the  unceas- 
ing discussion  of  these  subjects  1  For  that  kind  of 
anxiety  which  induces  action  to  avert  threatened 
evils,  there  seems  to  be  some  real  occasion.  It  is 
well  known,  in  the  first  place,  that  thousands  of  rude, 
ignorant  men  have  entered  the  profession,  attracted 
by  its  apparent  profitableness,  and  debarred  by  no 
law,  no  established  usage,  and  by  no  intelligent  dis- 
crimination of  the  public  against  uneducated  practi- 
tioners. In  the  second  place,  it  is  not  a  favorable 
sign  that  the  best  literature  on  dentistry  is  not  of 
American  origin,  —  that  literature,  namely,  which 
manifests  sustained  scientific  enthusiasm,  and  is  the 
result  of  disinterested  devotion  to  study,  on  the  one 


hand,  and  to  teaching,  on  the  other.  The  condition 
of  the  dental  schools,  which  have  been  established 
throughout  the  country,  gives  another  real  ground  of 
anxiety  about  the  future  of  the  profession.  These 
schools  receive  but  a  small  proportion  of  the  men 
who  enter  the  profession ;  and  they  set  before  the 
young  men  who  do  enter  them  much  too  low  a  stand- 
ard of  attainment.  As  the  future  of  a  profession  — 
whatever  may  be  its  present  —  is  largely  determined 
by  the  nature  of  the  education  which  the  youth 
who  enter  it  receive,  it  is  the  condition  of  dental 
schools  —  the  organized  means  of  education  for  the 
profession  —  which  should  first  engage  the  attention 
of  those  who  wish  to  place  dentistry  on  a  level  with 
the  learned  professions.  All  the  evils  which  threaten 
the  profession  would  gradually  but  surely  disappear, 
if  dental  schools  could  be  made  independent,  strict, 
and  thorough,  and  public  opinion  could  be  so  enlight- 
ened as  to  make  the  calling  inaccessible  or  profitless 
to  uneducated  men.  Let  us,  then,  examine  the  vari- 
ous points  at  which  American  dental  schools  admit  of 
improvement. 

The  first  fact  which  strikes  one,  at  the  outset  of 
an  inquiry  into  the  methods  and  practices  of  dental 
schools,  is  that  most  of  them  do  not  demand,  as  a 
qualification  for  admission,  any  preliminary  education 
whatever.  No  matter  how  ignorant  and  untrained  a 
man  may  be,  most  dental  schools  are  open  to  him. 
Three  schools,  two  of  which  are  by  no  means  of  the 


strongest  sort,  state  in  effect  that  a  knowledge  of  the 
ordinary  branches   of  an   English  education  is  neces- 
sary for  admission.     This  statement  is  obscure  ;  but 
it  probably  means  that  candidates  for  admission  must 
be   able  to  read,  write,   and   cipher.     Until  very  re- 
cently, all  the  medical  and  law  schools  in  the  United 
States  were    in    the    same   ignominious   condition   as 
regards  accessibility  to  the  ignorant ;  so  that  this  dis- 
grace   is   by  no   means    peculiar   to    dental    schools. 
Among  American  professional  schools,  the  theological 
schools  alone,  and  not  all  of  them,  have  escaped  this 
degradation.     The  disastrous  consequences  have  been 
brought  to   light  only  within   recent  years  ;  for   very 
few  professional  schools  in  this  country  are  over  forty 
years  old,  and  it  takes  a   generation,  at  the  least,  to 
exhibit  the  fruits  of  mistakes  in  educational  systems  ; 
but  the  consequences  have  been  grave  enough  already 
to  excite  the  alarm  of  the  professions,  and  to  induce 
leading  schools  in  both  law  and  medicine  to  institute 
admission    examinations.      It   would    be    difficult    to 
exaggerate  the  effect,  upon  the  estimation  in  which 
the  professions  of  medicine  and  dentistry  are  held,  of 
the  fact  that,   until  within  two  years,   these  profes- 
sions have  been  accessible  to  men  who  could  barely 
read    and  write,  and  have  been  actually  entered  by 
thousands  of  persons  who  never  received,  at  school 
or  college,  the  early  training  which,  in  the  great  ma- 
jority of  cases,  is  an  essential  preliminary  to  a  life  of 
refinement  and  cultivation.     It  is  the  more  important 


that  dentists  should  be  cultivated  men,  because  den- 
tistry is  a  calling  necessarily  pursued  for  the  most 
part  in  cities  and  large  towns,  and  because,  on  the 
whole,  the  profession  relies  for  its  support  upon  the 
educated  part  of  the  community.  Like  the  physi- 
cian, the  dentist  comes  into  more  or  less  confiden- 
tial relations  with  his  patients,  although  he  never  is 
obliged  to  take  the  heavy  responsibility  which  now 
and  then  is  suddenly  laid  upon  the  physician.  To  be 
the  equal  or  the  superior  of  his  patient  in  general 
cultivation  is  most  desirable  for  a  dentist :  he  should 
be  as  gentle  in  speech  and  manners  as  in  touch. 

The  English  Parliament  has  lately  enacted  (Den- 
tists' Act,  1878,  41  &  42  Vict.  ch.  33)  that  dentists  in 
Great  Britain  and  Ireland  shall  hereafter  be  persons 
approved  and  licensed  by  competent  professional 
bodies,  and  registered  by  government ;  and,  in  Eng- 
land, the  authorized  licensing  body  (the  Royal  College 
of  Surgeons)  has  already  prescribed  a  preliminary  ex- 
amination in  arts,  which  all  candidates  for  admission 
to  the  Dentists'  Register  must  pass  before  they  begin 
their  professional  training,  unless  they  are  Bachelors 
of  Arts  or  have  passed  certain  specified  university 
examinations.  This  examination  covers  English, 
Latin,  arithmetic,  algebra,  geometry,  geography,  and 
English  history,  and  any  one  of  the  following  subjects 
at  the  candidate's  option :  Greek,  French,  German, 
mechanics,  chemistry,  and  botany  and  zoology.  The 
examinations  are  all  elementary  in  character,  but  their 


10 

range  is  considerable.  There  is  no  need  of  argument 
to  prove  that  such  conditions  of  entrance  as  these 
will,  in  the  course  of  twenty  years,  greatly  improve 
the  quality  of  the  mass  of  the  profession  in  England  ; 
and  it  is  the  mass,  and  not  the  few  persons  of  excep- 
tional gifts,  that  educational  regulations  are  always 
intended  to  aifect.  If  American  dentistry,  as  a  pro- 
fession, is  to  maintain  its  rank  in  the  world,  it  must 
be  defended  by  similar  requisitions  against  the  incur- 
sion of  uneducated  men. 

It  is  undoubtedly  within  the  power  of  the  profession 
itself,  if  it  be  so  minded,  to  procure  the  establishment 
of  admission  examinations  at  dental  schools.  The 
force  of  a  concentrated  public  opinion  in  any  profes- 
sion is  very  strong  ;  and  it  need  not  be  the  opinion  of 
the  majority,  if  only  it  is  the  opinion  of  the  more 
intelligent  part  of  the  profession  forcibly  and  inces- 
santly expressed.  The  great  improvements  in  medical 
education,  which  have  been  made  by  a  few  schools  in 
this  country  since  1871,  illustrate  strikingly  the  effec- 
tiveness of  professional  opinion,  when  exerted  for  the 
purpose  of  directing  into  better  ways  and  to  higher 
ends  professional  education.  These  improvements 
might  not  have  been  attempted  but  for  the  urgency 
of  the  best  part  of  the  medical  profession,  and  they 
certainly  could  not  have  been  successfully  carried  into 
effect  without  the  steady  and  hearty  support  of  the 
profession  as  a  whole.  Again,  the  standard  of  admis- 
sion to  the  bar  in  the  State  of  New  York  has  been 


11 


much  raised  within  eighteen  months,  solely  by  the 
force  of  professional  opinion  made  effective  in  the  leg- 
islature and  the  courts  ;  and  this  was  accomplished  not 
only  without  the  help  of  the  local  law  schools,  but  in 
spite  of  all  the  influence  they  could  exert.  The  fact  is, 
that  any  profession,  if  it  is  in  earnest,  can  find  weap- 
ons with  which  to  defend  itself  against  deterioration. 
It  should  be  borne  in  mind  that  it  would  be  sufficient  to 
regulate  properly  future  admissions  to  the  profession. 
If  the  future  be  made  safe,  the  evils  of  the  present 
can  be  patiently  endured.  In  surprisingly  few  years, 
the  well-educated  young  men  would  push  out  those 
older  untrained  practitioners  whom  not  even  the  prac- 
tice of  many  years  had  much  informed. 

But  if  this  absence  of  a  preliminary  examination 
to  secure  some  degree  of  liberal  education  is  an  evil 
common  to  most  schools  of  law  and  medicine,  as  well 
as  to  dental  schools,  this  common  lack  will  not  explain 
the  admitted  fact  that  graduates  in  dentistry  do  not 
stand  on  a  level  with  graduates  in  law  and  medicine 
in  public  esteem.  The  reasons  for  this  disadvan- 
tageous position  of  dental  graduates  must  then  be 
sought  elsewhere ;  and  they  are  not  far  to  seek. 

The  period  of  study  for  the  dental  degree  is  deci- 
dedly shorter  than  for  the  medical  degree  or  for 
admission  to  the  bar.  Three  full  years  of  medical 
study  are  required  of  candidates  for  the  degree  of 
doctor  of  medicine,  and  three  years  of  legal  study  is 
the  common  requirement  for   admission  to  the  bar. 


12 


In  most  American  dental  schools,  two  years  is  the 
period  of  study  demanded  of  candidates  for  the  de- 
gree, and  one  of  these  years  may  be  replaced  by 
live  years  of  practice.  Two  schools  have  very  lately 
required  of  candidates  for  their  degree  three  years' 
study  of  dentistry,  and  one  other  school  has  given 
notice  that  it  intends  to  make  that  demand.  On  the 
other  hand,  two  schools  offer  their  degree  upon  exam- 
ination after  attendance  upon  a  lecture  course  of  four 
months'  duration,  without  further  inquiry  into  the  can- 
didate's qualifications.  During  the  two  years  which 
constitute  the  common  period  of  study,  the  dental 
student  must  give  a  large  part  of  his  time  to  the  ac- 
quisition of  manual  skill.  For  those  studies  which 
cultivate  and  enrich  the  mind,  the  ordinary  period  of 
dental  education  gives  small  opportunity  indeed.  The 
alert  intelligence,  the  scientific  habit  of  thought,  the 
power  of  original  investigation  —  precious  products  of 
prolonged  study  —  the  dental  student  cannot  hope  to 
acquire  during  his  brief  apprenticeship.  The  train- 
ing which  an  intelligent  and  faithful  student  of  medi- 
cine receives  during  his  three  years  of  study  is  very 
valuable,  regarded  merely  as  intellectual  discipline. 
Even  if  his  preliminary  education  has  been  neglected, 
the  assiduous  medical  student  has  some  chance  of 
acquiring  power  of  application,  and  the  habit  of  scru- 
tinizing phenomena,  and  comparing  and  reflecting 
upon  facts.  The  dental  student  has  no  such  oppor- 
tunity of  culture :  his   time  is  shorter,   and  he  must 


13 


learn  to  use  his  fingers  and  his  instruments.  It  is 
clear,  therefore,  that  the  public  is  quite  right  in  setting 
the  average  graduate  in  dentistry  below  the  average 
graduate  in  medicine ;  for  the  young  dentist  has  not 
had  more  than  half  of  the  mental  training  of  the 
young  physician,  and  must  be  his  inferior  both  in  ac- 
quired knowledge  and  in  disciplined  power.  A  pro- 
longation of  the  period  of  dental  study  is  absolutely 
essential  to  the  establishment  of  the  profession  upon 
an  equality  with  the  older  professions. 

Again,  the  dental  schools  have  copied  from  Amer- 
ican medical  schools  the  irrational  division  of  the 
year  into  a  fall  term,  a  winter  session,  and  a  spring 
terra.  The  fall  term  is  a  disconnected  fragment ; 
the  winter  session  is  supposed  to  be  complete  in  it- 
self, and  therefore  inevitably  becomes  an  indigestible 
mass  of  lectures  and  demonstrations,  crowded  one 
upon  another,  and  repeated  without  essential  change 
year  after  year ;  while  the  spring  term  is  another 
fragment,  which  is  neither  complete  in  itself,  nor  de- 
signed to  complete  what  has  gone  before.  Attendance 
at  the  winter  session  only,  if  once  repeated,  suffices 
for  graduation,  though  this  obligatory  session  is  in 
many  schools  but  four  months  long,  and  in  none  more 
than  five  and  a  half  months.  The  Harvard  Dental 
School  stands  alone  in  renouncing  completely  this 
division  of  the  year,  and  carrying  its  instruction  con- 
secutively through  the  academic  year,  from  October  1 
to  July  1.   For  the  orderly  and  progressive  treatment  of 


14 


great  subjects  like  anatomy,  physiology,  and  chemis- 
try, it  is  difficult  to  imagine  a  worse  division  of  the 
academic  year  than  that  which  has  so  long  prevailed 
in  American  medical  and  dental  schools.  In  their 
medical  schools.  Harvard  University  and  the  Univer- 
sity of  Michigan  have  completely  abandoned  this 
unprofitable  system,  and  the  University  of  Pennsylva- 
nia is  in  the  way  to  abandon  it.  It  will  be  a  good 
day  for  medical  and  dental  education,  when  all 
respectable  institutions  have  adopted  the  rational 
method  of  giving  progressive  instruction  throughout 
the  year. 

Many  dental  schools  accept  five  years  of  practice  as 
a  dentist,  instead  of  one  year  of  study  of  dentistry, 
thus  still  further  reducing  the  already  small  amount  of 
intellectual  training  required  for  the  degree.  If  a  man 
can  bring  evidence  that  he  has  practised  dentistry  five 
years,  —  no  matter  how  ignorantly,  —  he  can  obtain 
the  degree  of  one  of  these  schools  by  attending  a 
single  winter  session.  Is  not  the  public  right  in  re- 
garding the  American  dental  diploma  as  small  evi- 
dence of  general  culture  1  Is  it  always  good  evidence 
even  of  thorough  acquaintance  with  dentistry?  Five 
years  of  such  practice  as  a  person  without  education  is 
likely  to  have  will  aff"ord  but  limited  opportunities  for 
clinical  observation  and  study,  compared  with  those 
which  six  months  spent  at  a  well-conducted  school 
would  supply ;  and  the  ignorant  practitioner,  left  to 
himself  without  the  guidance  of  experienced  teachers. 


15 


is  in  no  condition  to  profit  even  b}^  those  opportunities 
which  offer. 

The  most  carefully  administered  dental  schools,  like 
all  medical  schools,  give  weight  to  practitioners'  cer- 
tificates of  time  spent  in  professional  study  by  young 
men  under  their  charge  or  observation.  The  precau- 
tions observed  in  receiving  these  certificates  are  too 
often  inadequate.  In  the  first  place,  these  certificates 
are  generally  written  at  the  time  the  student  presents 
himself  for  graduation,  and  they  therefore  reach  back 
over  a  preceding  period  which  is  often  three  years 
long.  In  large  schools,  it  frequently  happens  that  the 
certifying  practitioner  is  a  stranger,  living,  perhaps, 
far  away,  and  of  unknown  competency  as  an  instructor. 
It  is  nowadays  an  admitted  fact  that  physicians  and 
dentists  in  full  practice  are  seldom  willing  to  give  per- 
sonal instruction  to  private  pupils  :  they  can  use  their 
time  to  better  advantage.  Accordingly,  many  certifi- 
cates are  accepted  from  private  practitioners  in  a  form 
which  does  not  testify  that  the  student  on  whose  be- 
half the  certificate  is  given  has  received  any  personal 
instruction  from  the  signer,  but  simply  alleges  that 
th^  young  man  has  pursued  professional  studies  under 
his  observation.  Two  improvements  in  this  system  are 
much  to  be  desired :  the  first  is,  that  the  commence- 
ment of  medical  or  dental  study  should  be  certified  to 
at  the  time,  and  not  years  afterward,  by  the  prac- 
titioner who  has  cognizance  of  it  ;  and  that  the  stu- 
dent's time  should  count  only  from  the  reception  of 


16 


this  certificate  at  the  school  where  he  matriculates  : 
the  second  is,  that  certificates  should  be  received  only 
from  practitioners  who  have  facihties  for  giving  clin- 
ical instruction  through  their  connection  with  hospi- 
tals, asylums,  dispensaries,  infirmaries,  or  like  estab- 
lishments, in  which  opportunity  for  giving  practical 
instruction  is  afl"orded.  Both  these  securities  are  ob- 
tained in  England,  and  there  can  be  no  question  either 
of  their  feasibility  or  of  their  value. 

A  word  may  be  added  in  regard  to  a  much  needed 
change  in  the  prevailing  method  of  examining  for 
dental  degrees.  All  examinations  for  professional  de- 
grees should  be  public,  in  the  sense  that  the  questions 
asked  should  be  accessible  to  the  public,  and  the 
answers  of  candidates  should  be  subject  to  the  inspec- 
tion of  professional  men  who  have  not  been  the 
teachers  of  the  persons  examined.  An  oral  private 
examination  affords  no  guaranty  whatever  of  the 
worth  of  a  diploma.  If  dental  societies  and  legisla- 
tures propose  to  make  the  possession  of  a  dental 
diploma  an  essential  preliminary  to  admission  to  prac- 
tice, they  will  do  well  to  insist  in  the  first  instance 
upon  the  publicity  of  examinations  for  the  dental 
degree. 

Finally,  it  is  much  to  be  wished  that  a  moderate 
number  of  dental  schools  might  be  sufficiently  en- 
dowed to  be  reasonably  independent  of  students'  fees. 
With  the  exception  of  the  dental  school  of  the  Univer- 
sity of  Michigan,  which  is  mainly  supported  by  the 


17 


State,  the  dental  schools  are  dependent  for  support 
upon  tuition  and  graduation  fees ;  and  so  they  are 
tempted  to  keep  their  requisitions  low,  to  the  tem- 
porary pecuniary  advantage  of  the  schools,  but  to 
the  grave  injury  of  the  profession  and  the  community. 
No  form  of  professional  education  is  so  little  endowed 
in  this  country  as  dental  education ;  partly,  no 
doubt,  because  of  the  newness  of  the  calling,  and 
partly  also  because  the  need  of  thorough  education 
for  this  profession  has  only  lately  been  brought  home 
to  the  public  mind. 

I  take  up  next  a  subject  which  has  often  engaged 
the  attention  of  dental  societies,  and  been  discussed  in 
the  periodicals  of  the  profession  ;  namely,  the  re- 
lation between  the  degree  of  doctor  of  medicine  and 
the  degree  of  doctor  of  dental  medicine  or  dental 
surgery.  Many  eminent  dentists  have  regretted  the 
institution  of  a  special  dental  degree,  and  have  main- 
tained that  every  dentist  should  be  a  doctor  of  med- 
icine. Let  it  be  granted  at  once,  a^  a  fact  beyond 
dispute,  that  the  full  training  of  a  physician  and  sur- 
geon would  be  useful  to  a  dentist.  He  who  should 
follow  the  three  years'  course  for  the  doctorate  in 
medicine,  and  should  then  give  eighteen  months  or 
two  years  to  the  peculiar  studies  of  dentistry,  would 
be  a  much  better  trained  man  than  he  who  has  given 
but  three  years  in  all  to  professional  study.  But  it  is 
obvious  that  only  those  who  have  extraordinary  zeal, 


18 


and  an  unusual  amount  of  money  to  expend  upon 
their  education,  will  pursue  that  excellent  course. 
Young  Americans  who  intend  to  be  dentists  are,  as  a 
rule,  by  no  means  ready  for  such  deliberate  thorough- 
ness as  is  implied  in  the  suggestion  that  they  should 
first  qualify  themselves  as  physicians  or  surgeons,  and 
afterwards  as  dentists.  On  the  contrary,  they  are  still 
expecting  to  be  qualified  as  dentists  in  two  years  or 
less,  and  the  greater  number  of  dental  schools  are 
still  encouraging  this  expectation.  Whether  or  not 
the  dentist  shall  take  the  doctorate  in  medicine  is  at 
present  a  practical  question  in  this  country  only 
where  the  dental  candidate  for  the  medical  degree  is 
permitted  to  substitute  in  the  three  years'  course  for 
this  degree  all  the  peculiar  dental  studies  for  as  many 
proper  medical  and  surgical  studies. 

To  arrive  at  a  clear  opinion  upon  the  propriety  of 
allowing  such  substitutions,  and  of  conferring  the  one 
degree  of  doctor  of  medicine  for  courses  of  study  which 
diflfer  materially,  it  will  be  necessary  to  consider  how  far 
medical  and  dental  studies  are  identical,  and  how  far 
they  are  diverse.  The  fundamental  subjects  of  anatomy, 
physiology,  chemistry,  and  physics,  are,  indubitably, 
common  to  both  courses  of  study  ;  and  it  will  generally 
be  admitted  that  materia  medica,  oral  surgery,  a  con- 
siderable part  of  pathological  anatomy,  and  histology 
including  microscopy,  should  also  be  common  to  both  ; 
but,  when  in  the  three  years'  course  the  time  comes 
for   extensive    clinical    study  and  the   acquisition    of 


19 


manual  skill,  the  two  trainings  at  once  diverge.  The 
dentist  needs  much  technical  knowledge  and  skill 
which  the  medical  or  surgical  practitioner  never  has 
occasion  for ;  and,  on  the  other  hand,  the  physician  or 
surgeon  will  daily  avail  himself  of  information  and  ex- 
perience, for  which  the  dentist  will  never  have  any 
use.  Supposing  the  medical  and  the  dental  course  of 
study  to  be  each  three  years  long,  not  more  than  three 
fifths  of  the  studies  appropriate  to  the  two  courses 
are  common ;  at  least  two  fifths  are  diverse. 

Unlike  degrees  in  arts,  which  merely  indicate  a  cer- 
tain amount  of  liberal  study,  no  matter  in  what  sub- 
jects, professional  degrees  should  plainly  declare  the 
precise  sort  of  training  for  which  they  stand.  Since 
the  training  of  a  dentist  upon  a  three  years'  course  of 
study  is  in  good  measure  different  from  that  of  a  phy- 
sician or  surgeon,  it  may  well  culminate  in  a  special 
dental  degree,  easily  distinguished  from  the  degree  in 
medicine  ;  just  as  the  diff'erence  between  the  training 
of  a  civil  engineer  and  of  a  mining  engineer  is  wisely 
marked  by  the  use  of  two  degrees,  which  indicate  that 
the  trainings  for  these  scientific  professions  are  in 
good  part  diverse,  though  also  in  good  part  common. 
It  is  important  to  the  community  that  the  degree  of 
doctor  of  medicine  should  have  an  unmistakable  sig- 
nificance :  it  should  signify  that  the  person  thus  desig- 
nated has  pursued  certain  professional  studies,  to  the 
satisfaction  of  a  competent  Faculty.  Now,  if  a  person 
who  has  only  pursued  three  fifths  of  the  appropriate 


20 


studies  is  to  have  the  degree  of  doctor  of  medicine, 
the  significance  of  that  degree  is  obscured  and  im- 
paired. Moreover,  the  community  will  have  no  cer- 
tain evidence  that  the  dentist  who  holds  the  diploma 
of  doctor  of  medicine,  and  not  that  of  doctor  of  dental 
surgery  or  medicine,  has  ever  pursued  any  dental 
studies  at  all.  In  short,  by  permitting  the  use  of  the 
one  degree  of  doctor  of  medicine  to  designate  both 
physicians  and  dentists,  the  community  would  lose  in 
regard  to  both  professions  certain  securities  which  it 
now  possesses. 

In  the  light  of  these  obvious  facts,  let  us  consider 
the  recent  announcements  of  certain  dental  schools,  in 
combination  with  certain  medical  schools,  that  they 
will  give  the  degree  of  doctor  of  dental  surgery  and 
the  degree  of  doctor  of  medicine  for  the  same  three 
years  of  study.  Now  it  is  admitted  on  all  hands  that 
three  years  is  not  too  long  a  period  of  training  for  the 
degree  of  doctor  of  medicine,  when  the  whole  time 
is  devoted  to  proper  medical  studies ;  and  the  best 
opinion  is  that  three  years  is  not  too  long  a  time  to 
give  to  the  professional  education  of  a  dentist,  the 
whole  three  years  to  be  given  to  appropriate  studies 
and  the  acquisition  of  manual  skill.  Again,  we 
have  just  seen  that  not  more  than  three  fifths  of 
the  subjects  appropriate  to  these  two  professional 
courses  of  instruction  are  common  to  the  two.  Hence 
it  follows  that,  when  the  two  degrees  of  doctor  of 
medicine  and  doctor  of  deutal  surgery  are  given  for 


21 


the  same  three  years  of  study,  the  standard  of  one  or 
other  of  the  degrees  is  lowered  to  a  deplorable  extent. 
Beyond  a  doubt,  it  is  the  medical  degree  which  suffers 
in  the  first  instance ;  for  the  standard  of  that  degree 
is  at  present  higher  than  that  of  the  dental  degree. 
Indeed,  it  is  not  too  much  to  say  that  the  medical 
schools  which  have  entered  into  this  arrangement 
manifest  in  so  doing  a  want  of  respect  for  their  own 
degree.  They  may  in  this  way  contribute  for  a  few 
years  to  the  better  education  of  an  inconsiderable 
number  of  dentists  ;  but  in  doing  this  they  obscure  the 
meaning  and  impair  the  value  of  the  medical  degree, 
and  they  hinder  the  regeneration  of  the  dental  schools 
proper.  The  injury  they  thus  do  to  the  community 
by  sending  out  imperfectly  educated  men  bearing  the 
title  of  doctor  of  medicine,  but  not  properly  prepared 
to  practise  the  profession,  is  vastly  greater  than  any 
benefit  which  can  result  from  their  action,  either  to 
their  own  treasuries  or  to  the  dental  profession.  It 
is  matter  for  profound  regret  that  reputable  medical 
schools  have  adopted,  perhaps  without  distinctly  per- 
ceiving its  consequences,  this  most  unwise  and  dis- 
creditable policy. 

At  the  time  of  the  establishment  of  the  Harvard 
Dental  School  in  1868,  the  question  was  much  dis- 
cussed whether  it  would  be  better  to  institute  dental 
professorsliips  in  the  medical  school,  and  let  that 
school  give   a  special  dental  degree,  or  to  create  a 


22 


separate  dental  school  with  its  own  Faculty,  course  of 
instruction,  and  degree.  This  question  is,  however,  a 
question  of  form  rather  than  of  substance;  and  con- 
cerning these  different  forms  of  university  organization 
there  may  well  be  two  opinions  as  to  which  is  the  bet- 
ter. The  substance  may  be  secured  under  either  form  ; 
and  the  substance  is,  that  the  special  diploma  which 
testifies  to  the  public  that  the  holder  is  an  educated 
dentist  shall  be  procurable  only  by  devoting  three 
years  under  competent  guidance  to  the  appropriate 
study,  clinical  observation,  and  manual  practice. 

Let  me  next  ask  your  attention  to  a  brief  discussion 
of  some  means  of  elevating  a  liberal  profession  which 
are  not  educational.  Of  these,  the  first  which  I  wish 
to  speak  of  is  protective  legislation.  In  civilized  and 
populous  communities,  it  is  possible  to  exclude  by  law 
uneducated  persons  from  the  practice  of  learned 
professions.  The  governments  of  continental  Europe 
have  for  generations  regulated  admission  to  the 
professions  of  law  and  medicine  with  great  strictness. 
In  England,  the  organization  of  these  professions  has 
resembled  that  of  guilds  recognized  by  law.  In  this 
country,  until  within  recent  years,  the  learned  profes- 
sions can  hardly  be  said  to  have  had  any  protection 
at  all  against  the  incursion  of  uneducated  men.  The 
time  has  come,  however,  when  even  the  newer  Ameri- 
can States  perceive  the  importance  of  preventing 
quacks  and  impostors  from  tampering  with  the  health 


23 


of  the  population,  and  of  excluding  from  the  fiduciary 
profession  of  the  law  men  whose  capacity  and  honor 
have  not  the  foundation  and  visible  guaranty  of  good 
education.  Accordingly,  it  is  desirable  that  the 
opinion  of  the  professions  should  be  wisely  formed 
and  consistently  expressed  as  to  the  best  methods  of 
securing  due  protection  by  law.  The  centralized 
method  adopted  in  continental  Europe  —  the  method 
of  government  examinations  for  admission  to  govern- 
ment registers  —  is  not  applicable  in  this  country, 
being  consonant  with  neither  our  political  institutions 
nor  our  social  conditions.  A  system  of  examination 
and  registration  conducted  by  the  government  of  the 
United  States  is  not  to  be  looked  for :  first,  because  it 
is  no  part  of  the  constitutional  business  of  the  national 
government  to  regulate  the  professions ;  secondly, 
because  the  different  States  and  territories  have  differ- 
ent needs  ;  and,  thirdly,  because  the  chance  is  small  that 
the  national  government  would  appoint  competent  and 
impartial  examining  boards  in  a  manner  to  command 
the  respect  of  the  professions.  State  legislation  must 
therefore  be  relied  upon.  But  the  State  governments 
are  unfitted  by  their  popular  and  unstable  character  for 
the  direct  conduct  of  such  business  as  the  wise  regula- 
tion of  the  learned  professions.  They  almost  neces- 
sarily delegate  that  function  to  professional  bodies, 
acting  under  laws  of  a  general  character.  Thus, 
the  right  to  admit  to  the  bar  is  placed  in  the  hands 
of   the    courts ;    and    chartered   medical    and   dental 


24 


societies  have  received  from  legislatures  the  exclusive 
right  to  license  persons  to  practise  medicine  or  den- 
tistry.    For  example,  the  Statutes  of  New  Hampshire 
provide  that  "  it  shall  not  be  lawful  for  any  person, 
who  is  not  duly  authorized  to  practise  medicine  or 
surgery,  to  practise  dentistry,  unless  such  person  has 
received  a  dental  degree  from  some  college,  university, 
or  medical  school   authorized  to  confer  the  same,  or 
shall  have  obtained  a  license  from  the  New  Hampshire 
dental  society  "  (Chapter  CXXVI.  Sect.  3) ;  and  this 
society  is  duly  authorized  to  appoint  examiners  whose 
duty  it  is  to  examine  and  license  persons  to  practise 
dentistry.     The  Massachusetts  Medical  Society,  incor- 
porated by  the  State   in   1781,  affords  an   admirable 
demonstration  of  the  degree    of  protection  which   a 
learned  profession  can  secure  under  the  authority  of 
the  legislature  delegated  to  a  professional  organization. 
It  is  through  legislation  of  this  kind,  Avhich  intrusts 
the  right  to  license  to  professional  bodies,  that  a  de- 
fence against  ignorance  — not  complete,  by  any  means, 
but  still  of  great  value  —  may  best  be  secured  for  the 
professions  of  medicine  and  dentistry  in  the  States  of 
the  Union.     A  State  Register  would  be  likely  to  be- 
come a  sanctuary  for  quacks  and  empirics  of  every 
sort ;    for  professional    education  is   not   one   of   the 
subjects  upon  which  the  popular  judgment  is  valuable, 
or  which  may  wisely  be  left  to  the  decision  of  a  ma- 
jority vote;   and   legislatures,  if  well  constituted  for 
their  ordinary  functions  (as  we  must  assume  them  to 


25 

be),  would  certainly  be  unfit  to  determine  what  are 
the  proper  qualifications  for  the  practice  of  medicine 
or  dentistry,  and  would  in  all  probability  admit  to 
registration  with  a  freedom  which  would  make  the 
register  rather  a  refuge  for  ignorance  and  imposture 
than  a  barrier  against  them.  The  just  regulation  of 
the  learned  professions  requires  steady  action  upon  a 
definite  policy  through  a  long  series  of  years.  Now 
it  is  just  such  sustained  action  which  is  the  most 
difficult  for  popular  assemblies  ;  so  that  the  delegation 
of  their  powers  to  more  permanent  organizations  is 
wise  and  necessary  in  cases  where  a  far  reaching 
policy  is  to  be  unfalteringly  pursued.  It  should  not 
be  forgotten  that  legislation  of  the  restrictive  character 
desired  may  be  much  more  easily  procured,  if  it  be 
made  to  apply  only  to  the  future.  It  then  becomes 
the  interest  of  all  persons  already  established  in  re- 
putable practice  to  promote  such  enactments,  whereas 
retroactive  legislation  cannot  but  provoke  opposition 
and  do  some  actual  injustice.  As  has  been  already 
said  in  another  connection,  the  main  point  is  to  se- 
cure the  future  of  the  professions. 

So  young  a  profession  as  dentistry  may  well  look, 
in  searching  for  means  of  exalting  the  calling,  to 
the  experience  of  the  elder  profession  of  medicine. 
It  cannot  fail  to  be  observed  that  one  of  the 
things  which  makes  the  profession  of  medicine  a 
liberal  profession   is   the   zeal  for  scientific  research 


26 

which  animates  its  representative  men  throughout 
their  lives.  This  admirable  zeal  to  discover  truth 
and  to  make  it  prevail,  the  profession  of  dentistry- 
must  emulate  —  indeed  already  emulates.  In  this 
zeal  is  to  be  found,  on  the  one  hand,  evidence  that  the 
profession  is  entitled  to  call  itself  liberal,  and,  on  the 
other,  security  for  steady  growth  and  improvement. 

We  see  also  in  the  medical  profession  the  great  fact 
of  gratuitous  practice,  I  find  nothing  in  the  work  of 
missionaries  among  the  heathen  nobler  or  more  dis- 
interested than  this  gratuitous  practice  by  physicians 
and  surgeons  among  the  poor  and  wretched.  It  is 
one  of  the  most  admirable  of  charitable  works,  and 
demonstrates  with  singular  force  the  true  liberality  of 
the  profession.  Many  physicians  and  surgeons  of  the 
highest  standing  give  hours  every  day  to  hospital, 
dispensary,  or  infirmary  practice,  actuated  by  the  hope 
of  serving  their  fellow-creatures,  by  enthusiasm  for 
research,  and  by  desire  for  self-improvement  and  for 
the  greater  power  of  doing  good  which  in  the  practice 
of  medicine  follows  immediately  from  any  increase  of 
knowledge  or  skill.  The  establishment  of  infirmaries 
in  connection  with  dental  schools  has  given  some 
dentists  opportunities  for  gratuitous  practice ;  and 
some  hospitals  have  given  still  larger  opportunities  by 
including  among  their  out-patient  departments  a 
dental  infirmary.  But  much  still  remains  to  be  done 
before  dentistry  can  claim  equality  with  medicine  in 
this    respect.     The    profession    may    well    urge    the 


27 

establishment  of  gratuitous  dental  departments  in 
public  hospitals,  children's  asylums,  and  reformatory 
schools  :  the  actual  labor  of  such  services  would  fall 
chiefly  upon  young  practitioners,  the  supervision  being 
exercised  by  older  men. 

There  is  another  common  attribute  of  good  physi- 
cians and  surgeons  which  has  had  great  effect  to 
elevate  and  liberalize  their  profession,  —  I  mean  their 
characteristic  zeal  for  teaching.  This  zeal  is  mani- 
fested not  only  in  giving  direct  instruction  to  medical 
students,  but  in  imparting  to  medical  societies  and 
the  public  every  important  fact  observed,  every  useful 
practice  invented,  and  every  suggestive  opinion  or 
promising  theory  conceived.  The  constant  desire  and 
purpose  on  the  part  of  its  members  to  teach,  to 
impart  to  all  any  peculiar  knowledge  which  each  may 
acquire,  is  one  of  the  principal  distinctions  between  a 
liberal  profession  and  a  trade.  Dentistry  would  have 
no  claim  to  be  called  a  liberal  profession,  did  not  its 
practitioners  manifest  this  zeal  for  teaching.  In  this 
respect  a  great  change  for  the  better  has  taken  place 
in  the  profession  during  the  past  twenty  years. 

Associated  action  in  dental  academies  and  societies  is 
an  efficacious  means  of  strengthening  the  profession. 
There  is  wonderful  force  in  association  for  the  pursuit 
of  common  objects,  and  for  the  interchange  of  thought 
upon  matters  of  common  interest.  The  members  of 
any  learned   profession  are  necessarily  sundered  by 


28 


personal  interests  which  must  sometimes  clash  :  they 
should  be  united  by  a  strong  professional  spirit.  Or- 
ganizations for  scientific  and  social  purposes  promote 
a  good  understanding  between  their  members,  diffuse 
the  best  professional  opinions,  maintain  a  just  profes- 
sional etiquette,  and  give  effect  to  the  weightiest 
professional  character.  Dental  societies  might  answer 
another  very  important  purpose  :  they  might  create 
and  maintain  a  system  of  recording  the  life-histories, 
so  to  speak,  of  the  teeth  of  individuals  who  have 
been  under  observation  from  infancy  to  age.  The 
prolonged  life  and  permanent  records  of  societies  are 
obviously  necessary  for  this  purpose.  Many  persons 
employ  one  dentist  in  youth,  another  in  middle  life, 
and  a  third  in  age  ;  so  that  the  complete  record  of  any 
one  case  might  well  require  the  co-operation  of  three 
observers.  The  single  practitioner  cannot  record  the 
life-history  of  the  teeth  of  any  of  his  patients  who 
live  to  be  old :  his  old  patients  he  did  not  know  in 
their  youth,  and  his  young  patients  he  will  not  see 
in  their  age.  As  many  of  the  processes  of  dentistry 
must  still  be  regarded  as  experimental,  and  as  many 
years  are  often  required  to  bring  even  a  single  dental 
experiment  to  an  issue,  a  body  of  trustworthy  facts 
thus  accumulated  by  permanent  professional  societies 
would,  in  the  course  of  generations,  become  of  great 
value  by  supplying  decisive  means  of  discriminating 
between  good  processes  and  bad,  good  materials  and 
bad,  wise  treatment  and  foolish.     If  it  be  objected 


29 

that  the  life-records  of  hundreds  of  thousands  of  cases 
would  be  so  bulky  as  to  be  practically  inaccessible 
and  therefore  useless,  the  answer  is,  that  the  modern 
methods  of  cataloguing,  indexing,  and  summarizing  are 
quite  capable  of  surmounting  that  difficulty.  In  short, 
dental  societies  might  systematically  collect,  record,  and 
transmit  the  experience  of  the  profession. 

Perhaps  it  seems  to  you.  Gentlemen,  that  the 
measures  which  I  have  ventured  to  suggest,  and  the 
hopes  which  I  entertain,  are  extravagant  and  vision- 
ary ;  but  let  any  one,  who  doubts  about  the  progress 
which  the  near  future  has  in  store,  consider  what  the 
recent  past  has  seen  accomplished.  We  would  not 
ask  more  than  this,  —  that  the  progress  of  the  next 
ten  years  may  equal  the  progress  of  the  last  ten.  Of 
the  changes  in  dental  schools  which  I  have  advocated, 
the  larger  number  have  been  already  in  part  introduced, 
and  the  rest  have  been  thoroughly  proved  in  the  schools 
of  the  kindred  profession  of  medicine.  The  other 
means  of  elevating  the  profession  which  I  have  men- 
tioned are  not  untried ;  on  the  contrary,  their  value 
has  been  demonstrated  in  the  actual  experience  of 
other  professions.  Does  it  seem  to  any  of  you  that 
the  best  part  of  your  profession  has  no  weapons  with 
which  effectively  to  attack  abuses  intrenched  behind 
the  self-interest  of  the  few  who  profit  by  them  ?  Let 
me  assure  any  such  doubters  that  public  discussion 
is  a  weapon   very  formidable  to  those  who  for    sel- 


30 


fish  ends  maintain  abuses  or  resist  improvements. 
Instructed  by  the  history  of  the  professions  of  law 
and  medicine,  let  us  confide  in  the  power  for  good 
of  the  public  sentiment  of  the  profession,  expressed 
in  societies  like  this,  in  dental  journals,  and  in  daily 
conversation,  and  reinforced  by  the  informed  opinion 
of  the  educated  public. 


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